General Surgery Flashcards
1
Q
What is the best way to distinguish gastroesophageal reflux from other sources of epigastric distress?
A
PH monitoring his best to establish the presence of reflux
2
Q
When should endoscopy and biopsies of the esophagus be done?
A
If there is concern the damage may have been done to the lower esophagus or peptic esophagitis and possible development of Barrett’s esophagus
3
Q
When is esophageal surgery indicated?
A
Long-standing symptomatic disease that cannot be controlled by medical means, or anyone who developed complications, ulceration, stenosis and it’s imperative if there are severe dysplastic changes.
4
Q
What type of surgeries done on the esophagus?
A
Resection or laparoscopic Nissen fundoplication
5
Q
How can motility problems be diagnosed?
A
Barium swallow is typically done first. Manometry studies are used for definitive diagnosis.
6
Q
How is achalasia diagnosed?
A
manometry is diagnostic. X-rays show megaesophagus.
7
Q
Treatment for achalasia?
A
Balloon dilatation done by endoscopy
8
Q
Dysphagia that is worse for liquids
A
Achalasia
9
Q
Dysphasia starting with meats then other solids then soft foods eventually liquids and finally in several months saliva + significant weight loss that is almost always see
A
Cancer of the esophagus shows this classic progression
10
Q
Next step in management if esophageal cancer is suspected?
A
Barium swallow must precede the endoscopy to help prevent inadvertent perforation. Diagnosis is established with an endoscopy and biopsies. CT assesses operability, but most cases can only get palliative rather than curative surgery.
11
Q
What are the two types of esophageal cancer?
A
Squamous cell carcinoma – man with a history of smoking and drinking, blacks have high incidence. Adenocarcinoma - long-standing gastroesophageal reflux.
12
Q
Mallory-Weiss tear
A
Belong forceful vomiting eventually bright red blood comes up
13
Q
Do you diagnose a Mallory-Weiss tear?
A
Endoscopy establishes diagnosis, and allows for photocoagulation, laser.
14
Q
Boerhaave syndrome
A
Starts with prolonged, forceful vomiting leading to esophageal perforation. There is continuous, severe, wrenching epigastric and low sternal pain of sudden onset, soon followed by fever, leukocytosis, and a very sick – looking patient.
15
Q
Next step in management if Boerhaave syndrome is suspected?
A
Gastrografin first, barium if negative is diagnostic, and emergency surgical repair should follow. Delay in diagnosis and treatment as grave consequences.
16
Q
What is the most common reason for esophageal perforation?
A
Instrumental perforation of the esophagus. Shortly after completion of endoscopy symptoms similar to Boerhaave syndrome will develop. There maybe emphysema in the lower neck. Contrast studies and proper pair are imperative.
17
Q
Which patient population is more likely to get gastric adenocarcinoma? What are the typical symptoms?
A
More common in the elderly. There is anorexia, weight loss, and vague epigastric distress or early satiety. Occasionally hematemesis.
18
Q
How do you diagnose gastric adenocarcinoma and what is the treatment?
A
Endoscopy and biopsies or diagnostic. CT scan helps assess operability. Surgery is the best therapy.
19
Q
Incidence of gastric lymphoma versus gastric adenocarcinoma?
A
Gastric lymphoma is nowadays almost as common as gastric adenocarcinoma. Presentation and diagnosis are similar.
20
Q
Treatment for gastric lymphoma?
A
Chemotherapy or radiotherapy. Surgery is done if perforation is feared as the tumor melts away. Low-grade lymphomatoid transformation (MALTOMA) can be reversed by eradication of H. pylori.
21
Q
What are the signs and symptoms of a mechanical intestinal instruction?
A
1)Colicky abdominal pain and 2)protracted vomiting, 3)progressive abdominal distention if it is a low obstruction, and 4)no passage of gas or feces. Early on, 5)high pitch ball sounds coincide with the colicky pain after a few days there is silence.
22
Q
How do you diagnose and mechanical intestinal obstruction?
A
X-rays will show distended loops of small bowel, with air – fluid levels.
23
Q
What causes mechanical intestinal instruction?
A
Adhesions in those who have had a prior laparotomy.
24
Q
Treatment of mechanical intestinal obstruction
A
NPO, NG suction, IV fluids, hoping for spontaneous resolution or watching for early signs strangulation. Surgery if conservative management is unsuccessful, within 24 hours in cases of complete obstruction or within a few days in cases of partial obstruction.
25
Signs and symptoms of a strangulated obstruction
Colicky abdominal pain, protracted vomiting, progressive abdominal distention, no passage of gas or feces, development of fever, + leukocytosis, constant pain, signs of peritoneal irritation, and ultimately full-blown peritonitis and sepsis.
26
Carcinoid syndrome
Seen in patients with a small bowel carcinoid tumor with liver metastases.
27
Signs and symptoms of carcinoid syndrome?
Diarrhea, Flushing the face, wheezing, and right sided heart valvular damage look for prominent jugular venous pulse.
28
How do you diagnose carcinoid syndrome
24-hour urinary collection for 5-hydroxyindolacetic acid. Concentration of offending agent is only high during the time of the attack. A sample taken afterward will be normal. Thus, a 24 hour urine collection is more likely to provide the diagnosis.
29
Classic picture of acute appendicitis
Anorexia, followed by vague, Umbilical pain that several hours later becomes sharp, severe, constant, and localized to the RLQ of the abdomen. Tenderness, guarding, and rebound is found to the right and below the umbilicus. Moderate Fever and leukocytosis and a 10,000 to 15,000 range, with neutrophilia and immature forms. Emergency appendectomy should follow
30
What should you do in doubtful presentations that could be acute appendicitis?
Any cases that do not have all the classic findings should use a CT scan which is the standard diagnostic modality for these cases
31
Anemia (hypochromic iron deficiency) in the elderly for no good reason. Stools will be 4 plus for occult blood
Cancer of the right colon. Colonoscopy and biopsies or diagnostic; surgery – right hemicolectomy his treatment of choice
32
Bloody bowel movements. Blood coats the outside of the stool, and maybe constipation, stools may have narrow caliber. The next step?
Flexible proctosigmoidoscopy exam to 45 or 60 cm and biopsies are usually the first diagnostic study. Cancer of the left colon is suspected.
33
Surgical indications for chronic ulcerative colitis?
Disease present for longer than 20 years. High incidence of malignant degeneration, severe interference with nutritional status, multiple hospitalizations, need for high-dose steroids or immunosuppressants, or development of toxic megacolon.
34
What is toxic megacolon?
Abdominal pain, fever, leukocytosis, epigastric tenderness, massively distended transverse colon on X-rays with gas within the wall of the colon.
35
What is the definitive surgical treatment of chronic ulcerative colitis?
Removal of affected colon, including all of the affected mucosa which is always involved.
36
Pseudomembranous enterocolitis
Overgrowth of clostridium difficile who have been on Abx. M/C cause is cephalosporins. Clindamycin was the first described.
37
Symptoms of pseudomembranous enterocolitis
Profuse, watery diarrhea, crappy abdominal pain, fever, leukocytosis. Tocsin identified in stool
38
Treatment of pseudomembranous enterocolitis
Metronidazole with vancomycin serving as an alternative
39
Treatment for pseudomembranous enterocolitis unresponsive to treatment, with a WBC above 50,000 and serum lactate >5
Emergency colectomy
40
How do you rule out all in a rectal disease cancer
Proper physical exam, including proctosigmoidoscopy, even if clinical presentation may suggest a specific benign process
41
Anal fissure? who does that happen to and what are the symptoms?
Young women. Exquisite pain with defecation and blood streaked stools. Fear is so intense with bowel movements, constipation results.
42
Typical exam findings of an anal fissure?
Exam may need to be done under anesthesia, fissure is usually posterior in the midline.
43
Treatment of anal fissure?
Therapy is directed at relaxing tight sphincter (cause): stool softeners, topical nitroglycerin, local injection of botulinum toxin, forceful dilatation, or lateral internal sphincterotomy. Calcium channel blockers such as diltiazem ointment 2% TID topically for six weeks have had an 80 to 90% success rate compared to only 50% success for botulinum toxin.
44
Fissure, fistula, or small ulceration in the anal area that fails to heal and gets worse after surgical interventions.
Crohn disease – the anal area typically heals very well because it has an excellent blood supply. Surgery should not be done Crohn's disease of the anus.
45
Treatment for a fistula in crohn disease
Drained with Setons while medical therapy is underway. Remicade helps healing.
46
Rx for ischiorectal abscess
I&D, cancer should be ruled out. If patient is severely diabetic, horrible necrotizing soft tissue infection may follow: watch him closely
47
Possible complications of ischiorectal abscess that is drained? Treatment?
Fistula in ano - epithelial migration from the anal crypts, where the abscess originated and from the perennial skin form a permanent tract. Rule out the chronic and draining tumor treatment fistulotomy.
48
Etiology of squamous cell carcinoma of the anus
Fungating mass grows out of the anus, metastatic in with remotes are often felt. More common in HIV-positive.
49
Treatment for squamous cell carcinoma of the anus
Nigro Chemoradiation protocol, followed by surgery if there's residual tumor. 5-week chemoradiation protocol has a 90% success rate, so surgery is rarely required.
50
What locations of G.I. bleeds
Three or four cases originate in the upper G.I. tract, Usually younger patients. Older patients can develop from anywhere differential is angiodysplasia polyps diverticulosis or cancer
51
Vomiting blood
Always not the source within the upper G.I. tip of the nose to the ligament of Treitz
52
What is the next best diagnostic test after vomiting blood?
Upper G.I. endoscopy
53
NG tube aspirates blood where is the source?
Upper sources been established, follow with upper endoscopy
54
NG tube aspirates no blood, the fluid is white with no bio where is the source?
The territory from the tip of the nose to the pylorus has been excluded, the duodenum is still a potential source. Upper G.I. endoscopy should follow.
55
NG tube aspirates fluid that is green, bile tinged, where is the source of bleeding?
The entire upper G.I., tip of the nose to ligament of Treitz has been excluded, there is no need for an upper G.I. endoscopy.
56
When upper G.I. has been excluded, active bleeding per rectum, how do you determine the source?
If it exceeds 2mL per minute or one unit of blood every four hours do an angiogram. If less than 0.5 mLs per minute wait until bleeding stops and do a colonoscopy. If between 0.5 and two, do a tagged red blood cell study
57
Blood per rectum in a child
Meckel diverticulum. Start work up with technetium scan, looking for ectopic gastric mucosa.
58
Massive upper G.I. bleeding in the stressed, multiple trauma, or complicated post op patient is probably from? Treatment?
Stress ulcers. Endoscopy will confirm. Angiographic embolization is the best therapy. Maintain gastric pH above four.
59
What are the causes of acute abdominal pain?
Perforation, obstruction, inflammatory or ischemic processes.
60
Pain that is sudden onset and constant, generalized, and very severe. Patient is reluctant to move, and very protective of abdomen. Impressive generalized signs of peritoneal irritation of found: tenderness, muscle guarding, rebound, silent abdomen.
Acute abdominal pain caused by perforation: perforated peptic ulcer is the most common example. Emergency surgery is needed.
61
How do you confirm acute abdominal pain cosmic perforation?
Free air under the diaphragm and upright x-rays
62
Colicky pain, with typical location and radiation according to source. The patient most constantly, seeking a position of comfort. Physical findings, and the remote to the area where the process is
Acute abdominal pain caused by obstruction of a narrow duct: ureter cystic or common
63
Pain that is gradual onset and slow build up at the very least a couple of hours more commonly six or 10 or 12 ill-defined eventually locates to the area where the problem is with radiation patterns.
Acute abdominal pain caused by inflammatory process. Physical findings of peritoneal irritation with systemic signs of his fever and leukocytosis
64
Severe abdominal pain with blood in the lumen of the gut
Ischemic processes
65
Child with nephrosis and ascites, or the adult with ascites who has mild generalized acute abdomen with equivocal physical exam findings and perhaps fever and leukocytosis
Primary peritonitis. Cultures of the sciatic fluid will yield single organism treat with antibiotics
66
Acute abdominal pain in the left lower quadrant patient is middle age or beyond, there is fever, leukocytosis, physical findings of Peritoneal irritation
Acute diverticulitis
67
Best way to diagnose acute diverticulitis
CT scan
68
Best diagnostic tests for ureteral stones
CT scan
69
Volvus of the sigmoid
Old people, signs of intestinal obstruction and severe abdominal distention.
70
How do you diagnose Volvus of the sigmoid?
X-rays, show air fluid levels in the small bowel, very distended colon, huge air fluid loop in the right upper quadrant the tapers down toward the left lower quadrant with the shape of a parrots beak
71
Development of an acute abdomen and someone with atrial fibrillation or a recent MI. Diagnosis is delayed and patient is in acidosis and sepsis have developed.
Mesenteric ischemia – seen predominantly in the elderly
72
Treatment for mesenteric ischemia?
Arteriogram and embolectomy
73
Blood Marker for primary hepatoma
Alpha – fetoprotein
74
Most common liver cancer
Metastatic cancer to liver outnumbers primary cancer of the liver and United States by 20:1
75
Rising CEA and those who had call on cancer?
Concerning for cancer mets to the liver
76
Tenancy to rupture and bleed massively inside the abdomen, arise as a complication of birth control pills.
Hepatic adenomas
77
Complication of biliary tract disease, particularly acute ascending cholangitis. Fever, leukocytosis, tenor liver.
Pyogenic liver abscess
78
Men who have a Mexico connection
Amoebic abscess of the liver treatment metronidazole. Definitive diagnosis serology because the amoeba do not grow and pus
79
What are the three types of jaundice?
Hemolytic hepatocellular or obstructive
80
What labs are expected with hemolytic jaundice?
Usually low level of bilirubin usually 6-8, unconjugated, no elevation of direct with no bile in urine
81
Lab levels expected for hepatocellular jaundice?
Elevation of both fractions of bilirubin, very high transaminases, highest elevation of alkaline phosphatase. Hepatitis is the most common example
82
Last expected for obstructive jaundice?
Elevations of both fractions of bilirubin, modest elevation of transaminases, very high levels of alkaline phosphatase.
83
First step work up obstructive jaundice?
Sonogram looking for dilatation of the biliary ducts
84
What sign will be seen in a malignant obstruction?
A large, thin-walled, distended gallbladder is often identified (Courvoisier-Terrier sign)
85
Obstructive jaundice caused by stones should be suspected in which patient population?
Obese, fecund woman in her 40s, who has high alkaline phosphatase, dilated ducts on sonogram, non-dilated gallbladder.
86
First step in suspected obstructive jaundice caused by stones?
Endoscopic retrograde cholangiopancreatography (ERCP) to confirm the diagnosis, sphincterotomy, remove the common duct stone. Cholecystectomy should follow.
87
Which tumors cause obstructive jaundice?
Adenocarcinoma of the head of the pancreas, adenocarcinoma of the ampulla of Vater, or cholangiocarcinoma arising in the common duct.
88
Next step is obstructive jaundice caused by tumor is suspected?
Once tumor has been suspected by the presence of a dilated gallbladder and sonogram, the next test should be a CT scan. Percutaneous biopsy should follow. If CT is negative ERCP is the next that.
89
Malignant obstructive jaundice coincides with anemia and positive blood in stools.
Ampullary cancers
90
Causes biliary colic?
It occurs when a stone temporarily occludes the cystic duct
91
Common presentation of biliary colic
Colicky pain in the right upper quadrant, radiating to the right shoulder and belt like to the back, often triggered by ingestion of fatty food, accompanied by nausea and vomiting without signs of peritoneal irritation or systemic signs for the inflammatory process. Self limiting. Easily aborted by anticholinergics.
92
What causes acute cholecystitis?
Stats is biliary colic, but still remains at the cystic duct until an inflammatory process develops in the obstructed gallbladder
93
Presentation of acute cholecystitis?
Pain becomes constant, modest fever and leukocytosis, physical findings of peritoneal irritation in the right upper quadrant. Liver function tests minimally affected
94
Diagnostic signs of acute cholecystitis
Gallstones, thick walled gallbladder, Pericholecystic fluid
95
Treatment for acute cholecystitis
NG suction, NPO, IV fluids, and antibiotics will cool down most cases, allowing elective cholecystectomy to follow.
96
Treatment of acute cholecystitis in a very sick patient with prohibitive surgical risk?
Emergency percutaneous transhepatic cholecystostomy
97
What is acute ascending cholangitis?
Stones have reached the common duct producing partial obstruction and a sending infection. Patients often older and much sicker. Temperature spikes to104-105 with chills, and very high white blood cell count indicate sepsis.
98
What are the lab findings in acute a sending cholangitis?
Key finding is extremely high levels of alkaline phosphatase. There is some hyperbilirubinemia.
99
Treatment for acute ascending cholangitis?
IV antibiotics and emergency decompression of the common duct. Ideally by ERCP, or percutaneous through liver by PTC percutaneous transhepatic cholangiogram, rarely surgery eventually cholecystectomy has to follow.
100
How does biliary pancreatitis happened?
When stones become impacted distally in the ampulla temporarily obstructing both pancreatic and biliary ducts.
101
Types of acute pancreatitis?
edematous, hemorrhagic, suppurative
102
Acute edematous pancreatitis
Occurs in the alcoholic or patient with gallstones. Key finding to establish the edematous nature is an elevated hematocrit
103
Early lab clue that acute hemorrhagic pancreatitis is taking place
Lower hematocrit – the degree of amylase does not correlate with the severity of the disease
104
Treatment for acute hemorrhagic pancreatitis?
Daily CT scans. Intravenous imipenem or meropenem in those with a seizure disorder. ICU
105
Best way to deal with necrotic pancreas?
Necrosectomy. Wait 4 wees before debriding dead pancreatic tissue.
106
What is acute suppurative pancreatitis?
Pancreatic abscess: persistent fever and keukocytosis develop about 10 days after onset of pancreatitis.
107
Pancreatic pseudocyst
late sequela of acute pancreatitis or upper abdominal trauma. 5 weeks usually elapse after onset of acute pancreatitis.
108
Treatment of pancreatic pseudocyst
Cysts 6 cm or smaller - observe. Greather than 6 cm or older than 6 weeks are more likely to bleed or rupture. Drainage of cyst either percutaneously to the outside or drained surgically into the G I track or drained endoscopically into stomach
109
Chronic pancreatitis eventually develop into
Calcified burnt out pancreas, steatorrhea, diabetes, and constant epigastric pain.
110
What is gastrografin?
(Diatrizoic acid) High-osmolarity radiocontrast agent containing iodine. Lines GI tract, not as irritating but doesn't coat as well as barium. Good for patients allergic to barium.
111
Suspected diagnosis of sigmoid volvulus. Best next step in management?
Sigmoid volvulus is large bowel obstruction and must be decompressed prior to definitive management (Surgery to avoid recurrence) SIGMOIDOSCOPY (rigid or flexible) allowing time for bowel prep, then surgery.
112
Plain radiograph shows air in branching pattern over liver.
Biliary air seen in patient presenting with SBO 2/2 gallstone typically stuck at the ileo-cecal valve.
113
22 month old with colicky pain, marron-colored stools, paroxysmal nature of pain. Next step in diagnosis?
Dx: Intussusception -> BARIUM ENEMA is most successful in achieving the diagnosis and also therapeutic.
114
Febrile low grade, tachycardic, Rebound on deep palpation. WBC 15,000/mm3. Plain film shows dilated proximal small bowel with pneumatosis. Best next step in managment (NSIM).
Presence of peritoneal signs + pneumatosis = compromised or dead bowel, especially with leukocytosis and low grade temperature. Ex-lap is next step.
115
low grade temp, LLQ pain and tenderness, leukocytosis
Diverticulitis
116
Low grade temps, LLQ pain + tenderness, leukocytosis. NSIM?
(dx diverticulitis) CT ABDOMEN needed to confirm diagnosis and r/o other possible dx. Will help determine nature of diverticulitis complications (perforation or abscess)
117
44 y/o s/p lap chole 36 hours ago presenting with 8 hours severe periumbilical pain +v, febrile, tachycardic, respirations 22. 0.8 mg/dL and HIDA shows no bile leak. Best NSIM?
(Dx: Systemic sepsis and acute abdomen) in context of recent surgery: EX-LAP!! most likely a missed small bowel injury!
118
SIRS
> or = to 2 meets SIRS: Temp >100.4, HR >90, RR >20, WBC >12,000, 10% bands
119
Sepsis
SIRS + Source (suspected)
120
Severe sepsis
Lactic acidosis, SBP or = 40 mm Hg of normal
121
Septic shock
Severe sepsis with hypotension despite adequate fluid resucitation
122
Causes of SBO?
Adhesions (60%), Tumors (20%), Hernias
123
M/C location of GIT affected by Crohn's disease.
TERMINAL ILEUM
124
Non-bilious vomiting will cause this type of metabolic disturbance.
Hypochloremic hypokalemic metabolic alkalosis. Loss of H+ and Cl- with fluid cause dehydration. Kidney preserves protons at expense of potassium. Compensation will continue and H+ will be excreted in urine causing "paradoxical aciduria"
125
What is the most prominent symptom that differentiates choledocholithiasis from cholecystitis?
Jaundice, history of intermittent episodes of jaundice in the past or several day history of mild to moderate jaundice.
126
What would be considered an elevated percentage of neutrophils?
>70%
127
What are bands?
Immature neutrophils. This is known as a left shift with greater than 5% bands considered abnormal. Indicates an acute bacterial infection.
128
What would be the white blood cell count in cholelithiasis and choledocholithiasis?
Cholelithiasis and choledocholithiasis do not cause leukocytosis, neutrophilia, or a left shift, as there is no infection or significant inflammation present
129
White blood cell count in acute cholecystitis?
Classically associated with leukocytosis, elevated neutrophil count, and a left shift. 32% of patients will have normal white blood cell counts.
130
White blood cell count in cholangitis?
Nearly always exhibits leukocytosis, neutrophilia, left shift as this is often superlative and rapidly progressive infection. WBC count often exceeds 20,000
131
What are the Bilirubin levels in choledocholithiasis?
Initially causes a direct hyperbilirubinemia in 72-90% of patients without raising the indirect bilirubin level.
132
Classic presentation of cholangitis?
Charcot's triad of fever, jaundice and right upper quadrant pain. 60% of cholangitis patients will have jaundice while 88–100% have hyperbilirubinemia.
133
What does elevated alkaline phosphatase mean?
Alkaline phosphatase comprises a group of related enzymes found in biliary tract epithelium, bone, and placenta. Most often indicates stones in the common bile duct.
134
What are normal findings of the gallbladder ultrasound?
1)Gallbladder distended 2)wall <7 mm
135
Which imaging study test is the most specific for acute cholecystitis?
Ultrasound is more sensitive and specific than CT in diagnosing acute cholecystitis
136
The cystic artery is a branch of which artery?
Right hepatic artery
137
What day after surgery do most one infections manifest?
Post operative days 5–8 with erythema, edema, warmth, tenderness, and an exudate. fever is the most prominent systemic symptom.
138
For a suspected abscess after appendicitis what is the best next step in management?
CT scan
139
Next step in management for female with possible ovarian cyst or rupture?
Abdominal ultrasound
140
Diarrhea 10-25 times a day, blood and pus, abdominal pain, cramping that subsides after a BM, fever, weight loss, stools, tenesmus in a 15-30 year old or 50-70 year old.
Ulcerative colitis
141
M/C cause of intestinal obstruction between 2 months and 6 years of age.
```
Intussusception - most cases between 6 and 9 months of age
male to female ratio is 5:1
Sudden onset of severe paroxysmal pain
Currant jelly stool later manifestation
Mass in upper right portion
```
142
m/c cause of death from calciphylaxis?
Infection and or sepsis. 80% die from infection.
143
Pathophysiology of non-occlusive ischemic colitis
Low perfusion of colonic mucosa due to low cardiac output.
144
70 year old with h/o recent MI p/w sudden onset abdominal pain, vomiting, diarrhea and rectal bleeding. What diagnostic test should you order? What might you see?
non-occlusive ischemic colitis - scalloping or thumbprinting of the mucosal wall on barium enema. Diagnosis confirmed with colonoscopy - denmonstrates hemorrhagic, edematous, mucosal wall with superficial ulcerations.
145
Diagnostic test for suspected angiodysplasia?
Angiography useful in occlusive lesions such as arteriovenous fistulas and vascular steal syndrome.
146
Presentation of a patient with amoebic liver cysts?
Lives in Mexico, fever, leukocytosis, tender liver, elevated alkaline phosphatase
147
Hemorrhoids that bleed but do not hurt
Internal hemorrhoids
148
Hemorrhoids that hurt but do not bleed
External hemorrhoids
149
CC: Soiling of underwear after perirectal abscess drained
Fistula in ano
150
Young women had a baby, excruciating pain when they have a bowel movement and blood streaks on the toilet paper.
Anal fissure
151
Elderly patient with abdominal distensionm nausea, vomiting, colicky abdominal pain. No stool passed in 12 hours. No peritoneal irritation. Parrot's beak in left lower quadrant seen on abdominal X-ray. What is it? Management?
Sigmoid volvulus - common condition in elderly
Proctosigmoidoscopy - endoscopic instrument can untwist the bowel from the inside and allow placement of a long rectal tube. Corrective surgery if recurrent.
152
Obstructive jaundice + anemia + blood in stool
Ampullary cancer
